A short instructional YouTube talk by Dr. Peter Antevy advising EMS providers on treating pediatric croup. He notes racemic epinephrine is commonly recommended but often unavailable, and demonstrates using 1:1000 (1 mg/mL) epinephrine — 3 mL directly in a nebulizer — as an alternative. He also explains epinephrine’s beta-2 (bronchodilation) and alpha-1 (vasoconstriction) effects and suggests nebulized epinephrine can help selected severe asthma cases as well as croup.
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Hello, everyone. My name is Peter Anteve, and here for another edition of the Han Tevi Minute today is one of my favorite diagnoses is croup. Croup in EMS causes a lot of stress, and oftentimes I see a lot of EMS providers giving albuterol for croup. Now, we know that shouldn't be the.
Case, and oftentimes it's recommended to use racemic EPI.
For croup.
Now, we know that a lot of.
Us don't carry racemic epi. It comes as 0.5 ML, and then we're supposed to add 3 MLS of normal saline and put it into a nebulizer. So I would say that there's really no need for this because there's another.
Trick that you can use, and that is using EPI 1 to 1000 straight directly into the nebulizer.
So what I'm going to recommend is epinephrine 1 to 1000, which is also.
Known as 1 milligram per milliliter.
And you take 3mls of that and.
You put it directly into the nebulizer.
So let me show you what I mean. So here's EPI 1, 2000. I have three MLS. I'm going to take that out, I'm.
Going to insert it right into my nebulizer.
Close it off.
Now I'm ready to treat croup.
And so there's one additional thing that we haven't talked about yet, which is.
That nebulized EPI not only could be.
Used for croup like we just talked.
About, but another thing I like to use it for is asthma. And so some of you listening may say, well, haven't heard of that before.
But let's take a look at the physiology of that.
So Epi we know hits both the beta 2 receptors and the alpha receptors specifically. Let's talk about alpha 1. So for beta 2, we know this is the smooth muscle relaxation.
And for.
Alpha 1, this is a vasoconstrictor.
So at lower dosages it hits the beta 2.
So it does the same exact thing as albuterol would do for asthma.
And then the alpha one, the vasoconstrictor, that's where it's helping for croup.
And so oftentimes, if you have a really sick asthmatic who is circling the drain and you may have to intubate them, I often like to give them a little alpha one support, either by giving them EPI IM or have you.
So in this particular case, you can.
Kill two birds with one stone. By giving epi one to 1,000. That will help the asthmatic from a smooth muscle relaxation perspective and from a vasoconstriction perspective.
So consider using it for not just croup, but but for asthma.
And again, you're carrying it today. All you have to do is add it to your nebulizer. Thanks for another edition of the Hent heavy minute. I'm Dr. Peter Anteve.
